1. Penetrating Neck Trauma: Simulation Case Debriefing
Cullen B. Hegarty, M.D.
Regions Hospital
Department of Emergency Medicine

2. Debriefing: How did the case feel? What went well?
What would you change/do differently?
Crisis Resource Management review
Review of objectives and optimal management of the case

3. Case checklist: Address IV access, fluids
Order appropriate labs/blood products
Complete primary and secondary survey with full exposure/skin exam and vascular exam noted
Pain management
Early airway management with rescue technique(s) if needed
Coordinate final disposition for patient

4. Penetrating Neck Trauma:
Penetrating Neck Injury Karim Brohi, trauma.org 7:6, June 2002

5. Injuries: Stab wounds to the neck can result in: -Vascular -Neurologic
-Laryngotracheal and/or
-GI injuries

6. ED Management: Basic stabilization techniques
-ATLS Primary/Secondary surveys
-emphasis on exposure for other injuries
-screening x-rays (ex: CXR)
-early airway management
Diagnostic workup of injury

7. Diagnostic work-up Zone III: angiography if stable
Zone I: CXR, angiography, GI study (esophagoscopy vs contrast study) if stable
Zone II: OR for exploration versus (if stable)
-studies of potential injuries: angiogram, bronchoscopy, and GI study
-CT soft tissue neck
-clinical observation for signs/symptoms
All ‘Zones’ if unstable may need OR

8. Summary: Review of case, performance of clinical management and team
Review of penetrating neck injury
-Zones of neck
-Basic trauma stabilization techniques
-Management of injuries based on location of wound/zone

9. References:
Penetrating Neck Injury Karim Brohi, trauma.org 7:6, June 2002
Hamilton et al: Chapter 48 ‘Head and Neck Trauma’, pp ‘Emergency Medicine- An Approach to Clinical Problem-Solving, 2nd Edition’,Philladelphia, W.B. Saunders Company, 2003.